Coronary Artery Bypass Graft Surgery

During coronary artery bypass surgery, the surgeon removes a piece of blood vessel from the leg, chest, arm, or belly. Then the surgeon uses that piece of blood vessel (called a "graft") to reroute blood around the blocked artery. The surgery is called "bypass surgery" because it bypasses the blockage. Some people have more than one blocked artery bypassed. In this picture, the graft came from a vein in the leg called the "saphenous vein." But grafts can come from other places, too.

What is coronary artery bypass graft surgery? — This is a type of surgery that is used to treat coronary heart disease. The surgery is also known as “bypass surgery” or as “CABG” (pronounced “cabbage”).

In people who have coronary heart disease, the arteries that supply blood to the heart get clogged with fatty deposits (figure 1). This can block the flow of blood to parts of the heart muscle.

During bypass surgery, the surgeon uses healthy pieces of blood vessels from other parts of the body (called grafts) to re-route blood. Sometimes the surgeon does this by attaching a graft above and below a blockage, creating a bridge over the blockage. Other times, the surgeon redirects an artery that is supposed to supply the chest muscle and attaches it to the heart. These types of grafts allow blood to get past blockages and to the heart muscle that was not getting enough blood (figure 2).

Bypass surgery is usually recommended for people with coronary heart disease who either:

Continue to have chest pain and other symptoms, even though they are taking all the medicines that could help them; OR

Have blockages that are so big they could lead to heart attack or death

If your doctor recommends bypass surgery, ask these questions:

How might this procedure help me?

Will it help me live longer?

Will it reduce my chance of having a heart attack?

Will I feel better if I have this procedure than I would with medicines alone?

What are the risks of the procedure for me?

What happens if I don’t have this procedure?

How do I prepare for bypass surgery? — You will get detailed instructions from the hospital on how to prepare for your surgery. In general, you will need to stop eating by midnight the night before the surgery. You might also need to stop taking certain medicines several days before the surgery. Otherwise, you will not need to change much of your routine before the surgery.

What happens during bypass surgery? — Before the surgery you will be given medicines (called anesthesia) to help you relax and then to make you unconscious. That way you will not be aware of what happens during the surgery.

After you are unconscious, the surgeon will make a cut in the skin over your breastbone and then the breastbone itself to get at your heart. He or she will also cut out the piece or pieces of blood vessels that will be used as grafts. This could mean that the surgeon will need to make cuts in your arm, leg, belly, or within the chest itself.

When the surgeon is ready to attach the grafts, he or she will need to stop your heart for a short time. While your heart is stopped, a machine called the heart-lung machine will take over the work of your heart. The machine will keep blood flowing throughout your body. After the surgeon sews on the grafts, he or she can restart your heart and take you off the heart-lung machine.

If you have a newer type of bypass surgery, called “minimally invasive bypass surgery” or “off-pump surgery,” your surgery might be different from that described above. These approaches use a smaller chest incision and are done with the heart still beating. But they are not appropriate for all bypass situations and are not necessarily “better” than traditional surgery.

What happens after bypass surgery? — You will spend 1 to 2 days in an intensive care unit (also called an “ICU”). While in the ICU, you will be connected to machines that will monitor your heart, blood pressure, body temperature, and breathing. As you get stronger, you will need fewer and fewer of these machines. You will also have a number of tubes to help you breathe, urinate, and do other normal body functions. These will gradually be removed as you improve. When you are ready to leave the ICU, you will go to a regular hospital room for another few days.

The wound from the surgery will be sore for 2 to 3 days, but you will get pain medicines to deal with that. You will also have some tubes draining fluid from your chest.

During the few days after surgery, it is normal to have a poor appetite, be constipated, and have trouble sleeping. Give yourself time to get back to normal.

If you had a graft taken from your leg, you might notice some swelling in that leg after surgery. Elevating the leg and wearing special socks called “compression stockings” can help to reduce swelling.

What problems can happen after bypass surgery? — Most people do extremely well with bypass surgery, but there are a number of problems that can happen. The chances that any of them will affect you will depend on a lot of different factors, so ask your own doctor about the risks for you. In general, the most serious risks of bypass include:

Major bleeding

Heart attack

Heart failure, which is when the heart cannot pump enough blood

A heartbeat that is too fast or too slow

Stroke

Confusion and trouble thinking clearly

Lung problems

Wound infection (either in the chest or the body part where the grafts were taken)